Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice CONCLUSION
Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice CONCLUSION
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DOI：
10.1111/add.13675
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发表时间：
2017-02-01
期刊：
影响因子：
6
通讯作者：
Bray, Jeremy W.
中科院分区：
文献类型：
--
作者：
Babor, Thomas F.;Del Boca, Frances;Bray, Jeremy W.
目的本文介绍了美国物质滥用和精神卫生服务管理局（SAMHSA）资助的一项全国筛查、短暂干预和转诊治疗（SBIRT）示范计划的跨站点评估的主要结果和公共卫生影响。方法11个多站点计划在两个队列的SAMHSA赠款受助人分别资助5年，以促进采用和持续实施SBIRT。SBIRT跨站点评估使用多方法评估设计，以提供关于在各种医疗和社区环境中实施SBIRT的过程、结果和成本的全面信息。结果SBIRT计划在两个评估的SAMHSA队列筛选超过100万例患者/客户。坚定的领导和使用物质使用专家，而不是医学通才，提供服务，促进了SBIRT的实施。虽然结果评价的准实验性质不允许因果关系的推论，前后差异是有临床意义的，几乎每一个物质使用的措施，统计学显着。更大的干预强度与物质使用的大幅减少有关。短期干预和短期治疗都与积极的结果有关，但短期干预对大多数物质更具成本效益。69（67%）的原始性能网站适应和重新设计的SBIRT服务交付后，最初的赠款资金结束。影响SBIRT可持续性的四个因素：项目冠军的存在，资金的可用性，系统性变化和SBIRT供应商挑战的有效管理。结论美国物质滥用和精神卫生服务管理局的筛选，简短的干预和转诊治疗（SBIRT）示范计划成功地适应了早期识别工作的需要，危险使用酒精和非法药物。SBIRT是一种创新的方式，将物质使用障碍的管理纳入初级保健和普通医学。筛查、短期干预和转诊治疗的实施与治疗系统公平性、效率和经济性的改善相关。
Aims This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA). Methods Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings. Findings SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges. Conclusions The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.